Years ago, I saw the expression “cancer sucks” on a T-shirt of a middle school boy I knew whose mother had passed away from breast cancer the year before.

Although cancer deaths have declined for all cancers during the last two decades, cancer is the second leading cause of death behind heart disease and the leading cause of death in people younger than age 85.

Cancer is defined as growth of tissue or cells that are out of control and invading into other tissues or organs. Normal cells and tissues stay within their boundaries and perform a certain function. Cells are programmed to develop into specific types of tissue by the DNA in their nucleus.

If a defect develops in the DNA, the cell can transform into a cancerous cell. Cancerous tissue knows no boundaries and has the potential to spread sometimes locally and sometimes to tissues distant from where it originated.

Cancers tend to be more successfully treated if discovered early when the growth is small and localized. Some cancers have warning signs in the early stages while others do not.

One of the reasons the overall cancer death rate has declined is likely because more people are having cancer screenings that discover cancers in the early stages before symptoms occur. These techniques include mammograms for breast cancer, PAP smears for cervical cancer and colonoscopy or stool testing for colon cancer. Prostate cancer screening is not as enthusiastically endorsed, but still can be used in certain men (after discussing the pros and cons with their doctor) by testing the PSA level in the blood.

Some cancers, such as melanoma skin cancer, testicular cancer and lymphoma may be detected through routine self-examinations or routine examination by a provider. At this time, there are not accepted screenings for every type of cancer.

Recently, there have been recommendations for smokers to consider CT scanning of the chest as a technique to screen for lung cancer. Lung cancer is the deadliest cancer for both men and women. The screening can be done with yearly chest CT scanning in current smokers, (or those who have smoked within 15 years), are 55 to 80 years old and have smoked the equivalent of one pack per day for 30 years.

Some cancers can be linked to certain modifiable risk factors. An individual cannot reduce their risk to zero for cancer, but risk can be reduced. Smoking is the biggest risk factor for cancers, especially lung and urinary tract cancers. Some cancers have been linked to obesity. Sun exposure increases the risk of skin cancers. Other chemical and radiation exposures (like radon) also can increase risk.

Genetic markers can be identified for breast cancer risk and some women have mastectomies to prevent cancer if they have the high risk gene. Unfortunately, some cancers occur just by chance.

Due to earlier detection and better treatment, there are more people alive today who have been diagnosed with cancer than ever before. However, there are still serious limitations to cancer treatment. Some cancers are very difficult to detect early enough to provide a cure. Some are not responsive to surgery, radiation or chemotherapy. That is why cancer sucks. Sometimes, the best treatment is to provide comfort and support to patients and families as they go through this difficult transition.

Cancer treatment and screening has come a long way. There are effective treatments available today that were not available when I started practice. It is very likely that new treatments will be available in the future. But, for now, cancer still sucks.